There have been many subtle arguments over the years, about why the Canadian health-care system is better than the American one—how it costs less, how even the administrative overheads are lower, how it is fairer, how we don’t have 30 or 40 or however many million people who are uninsured. We all go into the same waiting rooms up here, regardless of race, colour, creed, personal wealth, or degree of suffering. Triage is much more equal here. It doesn’t matter who you are: “Take a number.”

In many ways, the health system, and many other arrangements in the former East Germany, were fairer than those in the former West Germany. Wages were more equal, for instance. And, except for members of the Communist Party, there were no rich people. None of the obscene spectacles, in the capitalist West, that people might glimpse from their rooftops—the bright lights and vulgar display of the Kurfürstendamm.

No, East Germany was the worker’s paradise, even a place of leisure—“we pretend to work and you pretend to pay us.” And East Berlin so wonderfully grey. Indeed, it was such a paradise, that the Communist authorities had to erect the Berlin Wall, to keep the victims of capitalism from flooding into their country. That, at least, was the subtle argument they advanced when they began building it. And in those good old days, there were fellow travellers in the West, willing to play subtle variations on that theme.

But from an obvious point of view, once the Wall was up, hardly anyone tried to climb it from the West. Well, OK, I once read a story about a mental patient who did attempt it; and I seem to remember the poor man was shot by the Communist guards, just as if he had been trying to cross the “killing zone” the other way. But in the main, people risked their very lives—in order to get not out of, but into capitalist West Berlin! (Can you believe it?)

Ditto with Canadian health care. It is so much better than the American system, so much fairer and more equal and—well, leisurely. You’d think all those Obama cadres would be clamouring to get into Canada, when they were sick. And yet, weirdly enough, the health-care traffic goes almost entirely the other way. People who are genuinely ill and can afford it—the premier of an oil-rich Canadian province comes to mind—mysteriously go to the United States for treatment. Why?

Because they think their own petty, miserable lives somehow worth saving.

The U.S. health care system is imperfect. There is general agreement on that. So is everything in this world imperfect, incidentally. Since time out of mind, subtle ideologues have argued that some perfect system of their imagining would be better than any imperfect system, mired as all those are in reality.

Polls ask different questions, and the same questions different ways, but it is obvious enough that an overwhelming majority of Americans did not want the “Obamacare” that was shoved down their throats by dubious parliamentary and constitutional means over the weekend. Scott Brown could never have been elected to the U.S. Senate were that not the case.

Instead, such is their humour that they would rather make their own decisions about their own medical care. Call them selfish, but they were not enthusiastic for reforms that increasingly penalize those who have made sound arrangements, for the benefit of those who cannot or will not. Charity for the poor is one thing; but this is something else.

Current problems with American health insurance began with government intervention many decades ago, when companies began offering competitive medical coverage to get around a government wage freeze. The tax system then reinforced insurance arrangements that were less than portable.

With the later expansion of medicare, the problems were compounded by a system of invisible taxation, in which those with private plans increasingly subsidized “government customers.” Government regulation had meanwhile twisted sound insurance principles—charging premiums that reflect risk and potential benefits—in arbitrary, ever so “worthy” ways.

Subtle (and easily refutable) arguments have been made about “saving money” and “fairness” and so on. In fact Obamacare takes everything that was wrong with U.S. medical insurance, and accelerates it. It invites the sort of catastrophe that followed from forcing banks to provide credit and mortgages to the kinds of customers banks would not previously touch. But on a much larger scale.

So what is the attraction? To “progressive” ideologues a fairly obvious one: it makes the American people far more dependent on government policy for every aspect of health care, whether or not their insurance policies are nominally “private.” And while people may be outraged in the short term, in the long run it creates a constantly expanding “client base”—of voters whose fears can be subtly manipulated by statist politicians.

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